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SAQ 1

You are an ED consultant driving to work one evening when you witness a small passenger bus roll over at 100kph. The driver is deceased on scene and the minibus appears to have up to 15 passengers. Two off-duty paramedics also pull over to assist you.

1. Briefly describe a triage system you may use to manage this scene. (3 marks)
2. You contact your hospital. State three key pieces of information you will give them and one request you will make of them. (4 marks)
3. Define mass casualty incident (MCI). (1 mark)
4. Briefly describe four differences between hospital based triage and external triage. (4 marks)

SAQ 2 (continued from SAQ 1)

You arrive at work only to find you are the most senior doctor on shift. The mass casualty protocol has been initiated and surgical/anaesthetic/ICU/Ortho are all aware of events.

1. For each of the following categories, list three steps you will immediately undertake to prepare for the influx. (6 marks)
   • Staff
   • Environment/space
   • Patients currently in department
2. List five non-medical groups/staff you may need to involve in this MCI. (5 marks)
3. List three ways your management of this situation would differ if the MCI involved a sarin gas attack rather than a bus accident. (3 marks)

SAQ 3

You are the ED director. Your staff have been accused of inappropriately allocating triage categories.

1. Define triage. (1 mark)
2. Complete the following table regarding Australasian Triage Scale (ATS) categories. (5 marks)

ATS category	Time to being seen	Goal % seen within time
1
2
3
4
5

3. What is the Australasian NEAT target? (2 marks)
4. Briefly describe four potential negative consequences of the NEAT target. (4 marks)
5. Define Access Block. (2 marks)

SAQ 4

You are the retrieval doctor for an intubated patient with head and chest injuries, who is to be retrieved to a tertiary hospital by fixed wing aircraft.

1. List two pros and two cons of fixed wing aircraft compared to helicopter transfer for patient transport. (4 marks)
   • Pros:
   • Cons:
2. List four measures you will undertake to minimise patient complications during transport. (4 marks)
3. List four details you will communicate to the receiving staff. (4 marks)
4. Would you give this patient seizure prophylaxis? Justify your answer. (2 marks)

SAQ 5

After a series of unfortunate incidents, you have been asked to educate the junior doctors on medicolegal principles, including capacity and competence.

1. Define capacity and competence. (2 marks)
2. You explain to the juniors that competence may be demonstrated if four elements are present. What are the four elements required to demonstrate competence? (4 marks)
3. A 58 year old female living alone, usually independent, presents with acute ischaemic gut. She requires immediate surgery to survive. Who can consent for this patient? (2 marks)
4. The patient is judged competent and declines surgery. Her pain is well controlled by strong oral opiates and she wishes to discharge herself home “to die”. List four ethical principles you will consider in deciding whether to allow her to self-discharge. (4 marks)

SAQ 6

You are the ED director. Your CEO has decided to save costs and reduce bed block by setting up a GP clinic adjacent to the ED to see priority 4 and 5 patients.

1. List three positive aspects and three negative aspects of this idea. (3 marks)
2. “GP style” patients are perceived by many to significantly increase ED numbers. What effect do these patients actually have on ED waiting times and access block? (2 marks)
3. You draft a pithy letter back to the CEO regarding access block, listing 6 factors which are proven to reduce access block. State them. (6 marks)
4. You also elect to educate him regarding what doesn’t work to reduce access block, listing the following three failed options. (3 marks)

SAQ 7

Your favourite registrar has just been assaulted…by a patient. The nurses point out that assaults have been more common recently.

1. List 3 possible reasons for an increase in violence in your ED. (3 marks)
2. Briefly describe how you would investigate this problem. (4 marks)
3. List 6 possible solutions to reduce the number of violent attacks in your ED. (6 marks)
4. The patient who attacked the Registrar is still aggressive. He was brought in by ambulance after a bar fight and is a frequent presenter for alcohol-related issues. The nurses ask if security can escort him off the premises. Briefly describe your response to the nurses and your next actions, with justification. (4 marks)